RISK ASSESSMENTS IN HIGH RISK OBSTETRIC WOMEN

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1 RISK ASSESSMENTS IN HIGH RISK OBSTETRIC WOMEN Working together to improve the safety of maternity services. Delcy Wells Head of Clinical Risk Co. Durham and Darlington Foundation Trust Supervisor of Midwives

2 RISK ASSESSMENT A generic risk assessment completed as soon as woman books Reviewed at every attendance to consider has any aspect changed increased risk or not Appropriate care setting low risk MLU high risk Consultant care Transfer between care setting must be documented well

3 Dual diagnosis diabetic+pregnant cardiac+pregnant mental health+pregnant etc Agreed management plan at onset agreed by all health professional with agreed regular reviews with documented decisions the care lead stated - case reviews important with all staff involved Reviewed at birth plan visit 36-37weeks so birth plan reflects all known risks Admitted in labour risk review

4 The role and function of NHSLA External organisational risk assessment The NHSLA (National Health Service Litigation Authority) administers the assessment process for organisational review and separate maternity services review The NHSLA provides the means for NHS organisations to fund the cost of clinical negligence claims. Organisational NHSLA standards and stand alone Maternity Services NHSLA standards are in place as maternity services is a high risk area with largest pay out to claims

5 How does the NHSLA assist the maternity services? Maternity services negligence claims can be in excess of a million for a cerebral palsy claim. The NHSLA has paid in excess of 55 million pounds in erbs palsy claims. Claims for eclampsia and preeclampsia cost in excess of 27million.

6 How does the NHSLA scheme benefit NHS Trusts? The Trust has a financial and quality incentive to contribute, on a pay as you go non profit basis. Assessments are awarded at three levels when compliance to the standards is demonstrated. The Trust s contributions decrease in accordance with the higher level achieved. Level 1 10% discount (Documenting policy) Level 2-20% (Implementing practice) Level 3-30% (Monitoring performance)

7 NHSLA risk assessment is seen as a financial incentive! False at directorate level the NHSLA standards are designed to: Provide a structural framework within which to FOCUS effective management to deliver quality improvements in organisational governance, patient care and the Safety of Patients. Increase awareness and encourage implementation of the National Agenda for the NHS and Maternity services.

8 CEMACH Aim to improve the health of mother s and babies by carrying out confidential enquiry related work on a nationwide basis disseminating findings and recommendations. Includes the overall remit for the two previous National Enquiries CESDI and CEMD

9 Audit Cycle Identify cases Implement Evaluate and refine Collect information Recommendations for action Analyse the results

10 A new title: a renewed purpose New title Top 10 recommendations and auditable standards Near misses UKOSS GP and Emergency Medicine chapters Better statistical rigour Top 10 Recommendations

11 Top 10 Recommendations 1. Preconception care 2 & 3. Access to care 4. Migrant women 5. Systolic hypertension requires treatment 6. Caesarean section 7. Clinical Skills 8. Clinical skills training 9. Early warning scoring system 10. National Guidelines

12 How does this affect the maternity services?

13 Operational risk assessments Individualised Child protection Social EWS-deteriorating patient Thrombosis Mental health issues Obesity North Yorkshire Airedale intrapartum risk assessment

14 NHSLA pilot maternity standards CEMACH is working with stakeholders including the Health Care commission for England to consider how the implementation and auditing of the Top Ten recommendations might best be achieved. The new NHSLA standards for maternity reinforce the implementation of these recommendations.

15 CEMACH and NHSLA promoteworking together to reduce morbidity and mortality within the maternity services.

16 Saving mother s lives There was no increase in the numbers of deaths associated with substandard care, however; A number of health professionals failed to identify and manage common medical emergencies or potential emergencies outside their field of expertise. Resuscitation skills were considered poor in some cases.

17 Care was hampered by a lack of multi-disciplinary working and problems with communication. The new NHSLA standards aim to address these shortfalls by maternity services giving evidence of clear risk, leadership, training and communication strategies.

18 NHSLA Pilot standards Compliance means implementation of the Top Ten CEMACH recommendations. Learning from adverse incidents and reflect this in clinical practice and training The maternity service is able to benchmark against best practice and standards to provide assurance to the inspecting bodies, stakeholders, families and users of the service. Gap Analysis of every document to consider is your unit the best it can be when considering national standards.

19 CDDFT NHSLA Maternity Assessment Our pilot assessment at Level 2 will be in October 2008

20 What this means is teamwork to achieve this!

21 We know why mother s die! We need to be proactive in Saving mother s lives Continual risk assessments and mitigate risks but we will never mitigate all risks as having a baby is not risk free

22 Thank you

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